Maternal morbidity and predictors of adverse outcomes in pregnant women with sickle cell disease: A nationwide analysis (2022)

Abstract Background: Pregnancy in women with sickle cell disease (SCD) is associated with high maternal morbidity, yet national-level contemporary data are limited. We aimed to characterize inpatient outcomes and identify predictors among pregnant women with SCD in the United States. Methods: Using the 2022 National Inpatient Sample, we analyzed all pregnancy-related hospitalizations for women with SCD identified via ICD-10-CM codes. Outcomes included in-hospital mortality, cesarean delivery, preterm birth, blood transfusion, hypertensive disorders, and severe complications (acute chest syndrome, stroke, venous thromboembolism [VTE], acute kidney injury [AKI], sepsis, mechanical ventilation). Resource utilization measures included prolonged length of stay (LOS >90th percentile) and high hospitalization charges (>75th percentile). Survey weights generated national estimates and 95% confidence intervals (CI). Multivariable survey-weighted logistic regression identified independent predictors. Results: Among 31,400 weighted hospitalizations (unweighted n=6,280), 81.2% of patients were Black, 11.1% Hispanic, and 61.5% Medicaid-insured; 88.9% occurred at urban teaching hospitals. Mean LOS was 4.2 days (95% CI: 3.97–4.44) and mean charges $39,334 (95% CI: $36,145–$42,523). Maternal mortality was rare (0.02%, 95% CI: 0.002–0.11), but morbidity was frequent: cesarean delivery (31.5%), hypertensive disorders (26.6%), preterm birth (5.5%), transfusion (4.8%), postpartum hemorrhage (5.4%), VTE (1.0%), and acute chest syndrome (0.6%). Prolonged LOS and high resource utilization occurred in 6.3% and 16.7% of hospitalizations, respectively. Predictors: Age ≥40 significantly increased odds of hypertensive disorders (OR 3.72, p<0.001), while Black race (vs White) remained independently associated (OR 1.51, p=0.049). Medicaid insurance was linked to higher odds of preterm birth (OR 3.61, p=0.03). Conclusions: Despite low maternal mortality, pregnant women with SCD experience substantial morbidity, particularly hypertensive disorders, cesarean delivery, and preterm birth. Disparities by age, race, and insurance status highlight urgent equity gaps. These findings underscore the need for targeted interventions, multidisciplinary care models, and policy strategies to improve maternal health outcomes in this high-risk population. Impact Statement: This study provides contemporary national estimates of pregnancy-related complications among women with SCD, identifying key disparities that inform targeted clinical and policy interventions. Limitations: The database lacks outpatient data and neonatal outcomes, and treatment details could not be captured.